The PACT Act and VA Disability: Toxic Exposure Claims Veterans Need to File
Posted by Gregory M. Rada | July 28, 2026 | Firm News
The PACT Act is the largest expansion of VA health care and disability benefits in decades, and it fundamentally changes how veterans with toxic exposure claims establish service connection. Signed into law in August 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act added more than 20 new presumptive conditions for veterans exposed to burn pits, Agent Orange, radiation, and other toxic substances during military service. For veterans who served in Southwest Asia, Afghanistan, and other qualifying locations, the PACT Act eliminates what was previously the hardest part of a toxic exposure claim: proving the connection between the exposure and the diagnosis. If you have a qualifying condition and served in a qualifying location during a qualifying period, VA presumes that your condition is service-connected. No nexus letter is required for a presumptive claim. But presumptive does not mean automatic. VA still denies PACT Act claims, and when it does, veterans have the right to appeal.
Table of Contents
- How Presumptive Service Connection Works Under the PACT Act
- Who Qualifies: Locations and Time Periods
- Burn Pit Presumptive Conditions
- Agent Orange Presumptive Conditions
- How VA Rates PACT Act Conditions
- When PACT Act Claims Get Denied
- PACT Act Conditions and TDIU
How Presumptive Service Connection Works Under the PACT Act
To receive VA disability compensation, a veteran normally needs to prove three things: a current medical diagnosis, an in-service event or exposure, and a medical nexus linking the two. For many toxic exposure claims, the second and third elements were historically the most difficult to prove. Veterans knew they had breathed burn pit smoke daily for a year. VA knew it too. But without a specific documented exposure event and a medical opinion connecting that exposure to a diagnosis years or decades later, claims were routinely denied.
The PACT Act addresses this by establishing presumptive service connection for a defined list of conditions. “Presumptive” means that if you served in a qualifying location during a qualifying time period and have been diagnosed with a qualifying condition, VA presumes the condition was caused by your service. You still need a current diagnosis from a medical provider, and you still need to show you served where and when the Act requires. But you do not need to independently prove the causal link between your exposure and your condition. VA accepts that link as a matter of law.
This is a significant change. Before the PACT Act, VA approved roughly 25% of claims related to burn pit exposure. In the first year after the Act took effect, the approval rate for PACT Act claims rose to approximately 78%, according to VA reporting.
Who Qualifies: Locations and Time Periods
The PACT Act establishes presumption of exposure for veterans who served in specific locations during specific periods. The two primary groups are Gulf War era veterans (service on or after August 2, 1990) and post-9/11 veterans (service on or after September 11, 2001).
For service on or after August 2, 1990, qualifying locations include Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates, and the airspace above these locations, as well as waters of the Arabian Sea, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, and the Red Sea.
For service on or after September 11, 2001, the list expands to include Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, and the airspace above these locations.
The PACT Act also added new presumptive locations for Agent Orange exposure, including any U.S. or Royal Thai military base in Thailand from January 9, 1962, through June 30, 1976; Laos from December 1, 1965, through September 30, 1969; Cambodia at Mimot or Krek, Kampong Cham Province from April 16, 1969, through April 30, 1969; Guam and American Samoa from January 9, 1962, through July 30, 1980; and Johnston Atoll from January 1, 1972, through September 30, 1977.
Your DD-214 and service personnel records are generally sufficient to establish that you served in a qualifying location. You do not need to produce evidence of a specific exposure incident.
Burn Pit Presumptive Conditions
The PACT Act added more than 20 presumptive conditions associated with burn pit and other toxic exposures. These fall into two broad categories: cancers and respiratory/other conditions.
The cancer presumptives include cancers of the head, neck, respiratory system, gastrointestinal system, reproductive system, urinary system, blood (leukemia and lymphoma), kidney, and brain. Melanomas, pancreatic cancer, and cancers of the eye are also included. The full list is extensive and covers more than 300 specific cancer types when subcategories are counted.
The respiratory and other condition presumptives include constrictive bronchiolitis, constrictive pericarditis, chronic sinusitis, chronic rhinitis, chronic laryngitis, glioblastoma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, sarcoidosis, granulomatous disease, interstitial lung disease, desquamative interstitial pneumonia, hypersensitivity pneumonitis, organizing pneumonia, pulmonary alveolar proteinosis, chronic pleuritis, pulmonary granuloma, pleuritis, and asthma (if diagnosed within 10 years of a qualifying exposure).
Not every condition a veteran develops after toxic exposure is on the presumptive list. But even if a condition is not listed, a veteran may still be able to establish service connection through direct or secondary service connection with appropriate medical evidence. The presumptive list makes the process easier for the conditions it covers, but it does not prevent veterans from filing claims for other conditions linked to toxic exposure.
Agent Orange Presumptive Conditions
The PACT Act added two new Agent Orange presumptive conditions: hypertension and monoclonal gammopathy of undetermined significance (MGUS). These join an existing list of Agent Orange presumptives that includes type 2 diabetes, ischemic heart disease, Parkinson’s disease, several cancers (including prostate cancer, bladder cancer, lung cancer, and non-Hodgkin’s lymphoma), chronic B-cell leukemias, peripheral neuropathy, and others.
The addition of hypertension is particularly significant. Hypertension is one of the most common conditions among Vietnam-era veterans. Many veterans who served in locations with Agent Orange exposure and have managed their blood pressure with medication for years may now be eligible for disability compensation. Even a veteran on medication whose blood pressure is controlled may qualify for a compensable rating under 38 C.F.R. § 4.104, Diagnostic Code 7101.
The expanded location list also matters. Veterans who served on Thai military bases during the Vietnam era, for example, may now qualify for Agent Orange presumptives when their claims were previously denied for lack of proven exposure.
How VA Rates PACT Act Conditions
The PACT Act does not create new rating criteria. Once VA grants service connection for a presumptive condition, the condition is rated under the same diagnostic codes and criteria that apply to any other service-connected disability. A veteran granted service connection for asthma under the PACT Act is rated under the respiratory diagnostic codes in 38 C.F.R. § 4.97. A veteran granted service connection for a PACT Act cancer is rated under the applicable cancer diagnostic codes.
This means that the rating assigned depends on the severity of the condition, and many of the same issues that arise in other VA claims apply here as well. VA may underrate the condition based on an inadequate C&P exam. VA may fail to consider functional limitations or secondary conditions. A veteran with PACT Act service-connected COPD who also develops depression because of the limitations the respiratory condition imposes may be entitled to secondary service connection for the depression. A veteran with a PACT Act cancer who undergoes treatment and is left with residual conditions may be entitled to separate ratings for those residuals.
The point is that getting service connection through the PACT Act is the first step, not the last. The rating that VA assigns determines the veteran’s monthly compensation, and that rating should accurately reflect the full severity of the condition.
When PACT Act Claims Get Denied
Despite the presumptive framework, VA still denies PACT Act claims. The most common reasons include the following.
VA may determine that the veteran’s service records do not confirm service in a qualifying location during a qualifying time period. This can happen when records are incomplete or when the veteran served in a location that borders a qualifying area. In some cases, supplemental evidence (travel orders, performance evaluations referencing a location, buddy statements from fellow service members) can fill the gap.
VA may find that the veteran does not have a current diagnosis of a presumptive condition. Presumptive service connection requires a confirmed medical diagnosis. If a veteran has symptoms consistent with a presumptive condition but has not yet been formally diagnosed, the claim may be denied. Getting a clear diagnosis from a qualified provider before filing, or ensuring VA schedules an adequate exam, is essential.
VA may concede the exposure and the diagnosis but assign a 0% (noncompensable) rating, meaning the veteran is service-connected but receives no monthly compensation. This can happen when VA determines the condition is currently asymptomatic or well-controlled. A 0% rating is still valuable because it establishes service connection (which can never be taken away if it has been in place for 10 years under 38 U.S.C. § 1159), qualifies the veteran for VA health care, and serves as the foundation for a future increased rating if the condition worsens or for secondary conditions that develop later.
If VA denies your PACT Act claim, you can appeal the decision through a supplemental claim with additional evidence, a higher-level review, or a Board appeal. For claims involving incomplete service records or diagnostic issues, a supplemental claim with new evidence is often the most effective path. For claims where the evidence already supports the grant and VA applied the wrong standard, a higher-level review requesting de novo review may be appropriate.
PACT Act Conditions and TDIU
Many of the conditions covered by the PACT Act are severe enough to prevent veterans from working. A veteran with service-connected COPD, pulmonary fibrosis, or cancer may be unable to perform physical labor, and the fatigue, treatment side effects, and cognitive limitations associated with these conditions may also prevent sedentary work.
If a PACT Act condition (alone or in combination with other service-connected disabilities) prevents a veteran from maintaining substantially gainful employment, the veteran may qualify for TDIU under 38 C.F.R. § 4.16. TDIU pays at the 100% rate ($3,938.58 per month for a single veteran in 2026), even if the veteran’s combined rating is less than 100%.
For veterans whose PACT Act conditions don’t meet the schedular thresholds for TDIU (one condition at 60% or a combined 70% with one at 40%), extraschedular TDIU under § 4.16(b) may still be available. This is particularly relevant for veterans with respiratory conditions rated at 30% who cannot work because of the condition’s effects on stamina, oxygen levels, and daily functioning.
The PACT Act opened the door for hundreds of thousands of veterans to receive benefits they were previously denied. But the door being open does not mean VA will get every decision right. If you have a condition related to burn pit exposure, Agent Orange, or other toxic substances encountered during military service, and VA has denied your claim or assigned a rating that doesn’t reflect the severity of your condition, contact After Service LLC for a free consultation. We represent veterans nationwide and can evaluate whether your claim has a strong basis for an appeal or an increased rating. Call us at 800-955-8596 or schedule a free consultation today.
